Efficacy of Stenting for High Cervical Internal Carotid Artery Dissection Presenting with Cerebral Ischemia : A Report of Three Cases

Objective: In this report, three patients with cervical internal carotid artery dissection (clCAD) successfully treated with stenting are presented, and the relevant literature is discussed. Case Presentations: Case 1: A 47-year-old man developed dysarthria, right facial palsy, right paresthesia, and left photophobia lasting for half an hour. MRI showed no new infarction, but angiography demonstrated a severe high cervical internal carotid artery (ICA) stenosis with a false lumen. He underwent stenting on the 9th day, and the lesion disappeared completely. His postoperative course was uneventful, and no recurrence has been observed to date. Case 2: A 34-year-old man noted episodes of mild headache and a transient left visual field defect and was brought to the hospital by ambulance. Initial diffusion-weighted MRI showed left ICA occlusion. Although his symptoms improved with iv rt-PA, global aphasia and right hemiparesis occurred after 4 h. Since his emergent DSA showed left clCAD with nearly complete occlusion, he underwent stenting. His symptoms improved dramatically, and he recovered fully in 3 months. Case 3: A 63-year-old man developed two transient episodes of mild right hemiparesis. Due to his recurrent symptoms, DSA was performed, and dissection was found at left cervical ICA of C1 level. Endovascular intervention with a stent was conducted, and no recurrence has been observed to date. Conclusion: Endovascular intervention using stent may play an important role in patients with clCAD having severe stenosis or recurrent ischemic stroke.